I'm a MS-4 doing an EM rotation now.
Pretty sure I'm going to be applying to the field.
Currently working shifts on a progressive schedule.
2 8 am - 4 PM, 1 3 PM -11 PM, 1 11PM - 7 AM, day off.
How do you guys sleep on this type of schedule?
Could you also comment on how you sleep on whatever schedule you are working out in residency or practice beyond?
Please give some specific hours if possible.
I don't mind working nights, weekends, holidays, whatever.
Just want to make sure I can adjust to the changing schedules.
Thanks.
Bottom line:
You have to choose when and where you want to suffer. There is no way to
eliminate the circadian disruption of rotating shift work, without eliminating the shift work. You can only
manage it.
In your above example, the 8-4, to 3-11 shift switch is a piece of cake. Going to the 11pm-7am is where things get tricky. Do you want to suffer
at work, or on your
free time? You have to decide or it will decide for you. If you want to be rested for your 11pm-7am shift, you
do not, I repeat
you do not go home after the 3pm-11pm shift and sleep from midnight to 8am. You go home after the 3-11, stay up until 3 or four in the morning and sleep no more than 4 hours. Yes, you're dead tired all day or your half day "off".....but, here's the advantage: before your 11pm shift you'll be so damn tired you'll nap 3-4 hours without a problem. This will make your 11pm-7am shift bearable.
You're not out of the woods yet. What do you do after your last night shift ends at 7am? Sleep all day like a normal person would? Absolutely not. That's a prescription for misery. In your above example, you state that after the rotation you have one day "off". If, in fact, you have only one day off before you go back to the 8am shift, you absofrickinlutely do not want to sleep all day like your body needs to. Why? If you sleep all day, you'll be up all night. If you're up all night, how do you think you're going to feel working the 8am shift all day not having slept at all, the night before? Terrible. So you sleep as little as possible: 1, 2, 3 or definitely no more than 4 hours. This and only this, will allow you to be TIRED ENOUGH, come midnight to actually sleep at night, so as to switch your body and mind back to day shift.
So, you have to pick. Suffer on your day off, and feel good at work? Or feel great on your day off, and suffer at work?
Sleeping pills don't work. Neither do stimulants. You can't cheat your circadian rhythms.
The only real solutions:
1-Pay your partners WHATEVER IT TAKES to get them to do all your nights and gladly accept the pay cut, or
2-Demand and expect a minimum of 4 FULL DAYS OFF after each switch from an overnight to your first day shift (because the first day isn't a day off. You work until 7am that day. The second and third days aren't days off because you're dead tired. Finally on your 4th "day off" you get your first real day "off", or
3-Never, I repeat, never work more than 128 hours per month. Why? Because
maximal recovery time is the only real way to deal with the stresses the circadian disruption causes to your body and mind, or
4-Be an ED director so you work as few clinical shifts as possible, or
5-Don't be an ER doctor.
That's how it's done.